Abstract
Purpose
To evaluate the effect of different passive maneuvers on upper airway patency during drug-induced sleep endoscopy (DISE) compared to recent literature on treatment outcomes of positional therapy (PT), oral appliance therapy (OAT), and combined treatment in obstructive sleep apnea (OSA) patients.
Methods
A retrospective, single-center cohort study including a consecutive series of 200 OSA patients. All patients underwent DISE with and without manually performed jaw thrust and lateral head rotation by using the VOTE classification. The effect of these maneuvers were analyzed by using the sum VOTE score comparing non-positional (NPP) and positional OSA patients (PP).
Results
Two hundred patients were included (80.5% male) with a mean age of 50.1 ± 11.7 years, a BMI of 27.0 ± 3.1 kg/m2, and a median AHI of 19.2 events per hour. Forty-four percent of the patients were NPP; of the remaining 56%, 34% was diagnosed with supine isolated and 66% with supine predominant POSA. Manually performed jaw thrust showed a reduction of sum VOTE score of 66.7% in all subgroups. The effect of lateral head rotation was a reduction of 33.3% in NPP and supine predominant PP and 50% in supine isolated PP. Combining these maneuvers a reduction of more than 75% was seen in all patients.
Conclusions
The present model leaves room for improvement. The effect of manually performed jaw thrust is greater and the effect of lateral head rotation alone is less than what was expected compared to recent literature on treatment outcome of OAT, PT, and combined treatment.
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References
Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G (1991) A comparative study of treatments for positional sleep apnea. Sleep 14(6):546–552
Heinzer R, Marti-Soler H, Haba-Rubio J (2016) Prevalence of sleep apnoea syndrome in the middle to old age general population. Lancet Respir Med 4(2):e5–e6. https://doi.org/10.1016/S2213-2600(16)00006-0
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172
Ravesloot M, Van Maanen J, Dun L, De Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea—a review of the literature. Sleep Breath 17(1):39–49
van Maanen JP, Meester KA, Dun LN, Koutsourelakis I, Witte BI, Laman DM, Hilgevoord AA, de Vries N (2013) The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath 17(2):771–779
van Maanen JP, de Vries N (2014) Long-term effectiveness and compliance of positional therapy with the sleep position trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep 37(7):1209–1215. https://doi.org/10.5665/sleep.3840
Benoist L, de Ruiter M, de Lange J, de Vries N (2017) A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med 34:109–117. https://doi.org/10.1016/j.sleep.2017.01.024
Richard W, Venker J, den Herder C, Kox D, van den Berg B, Laman M, van Tinteren H, de Vries N (2007) Acceptance and long-term compliance of nCPAP in obstructive sleep apnea. Eur Arch Otorhinolaryngol 264(9):1081–1086. https://doi.org/10.1007/s00405-007-0311-3
Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236. https://doi.org/10.1007/s00405-011-1633-8
De Vito A, Llatas MC, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18(3):453–465
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29(2):244–262
Johal A, Battagel JM, Kotecha BT (2005) Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea. Eur J Orthod 27(6):607–614. https://doi.org/10.1093/ejo/cji063
Johal A, Hector MP, Battagel JM, Kotecha BT (2007) Impact of sleep nasendoscopy on the outcome of mandibular advancement splint therapy in subjects with sleep-related breathing disorders. J Laryngol Otol 121(7):668–675. https://doi.org/10.1017/S0022215106003203
Vanderveken OM, Vroegop AV, van de Heyning PH, Braem MJ (2011) Drug-induced sleep endoscopy completed with a simulation bite approach for the prediction of the outcome of treatment of obstructive sleep apnea with mandibular repositioning appliances. Oper Tech Otolayngol Head Neck Surg 22(2):175–182
Vroegop AV, Vanderveken OM, Dieltjens M, Wouters K, Saldien V, Braem MJ (2013) Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res 22(3):348–355
de Ruiter MHT, Benoist LBL, de Vries N, de Lange J (2017) Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep Breath. https://doi.org/10.1007/s11325-017-1568-4
Dieltjens M, Vroegop AV, Verbruggen AE, Wouters K, Willemen M, De Backer WA, Verbraecken JA, Van de Heyning PH, Braem MJ, de Vries N, Vanderveken OM (2015) A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath 19(2):637–644. https://doi.org/10.1007/s11325-014-1068-8
Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, Van de Heyning PH, Hamans E (2014) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 124(3):797–802. https://doi.org/10.1002/lary.24479
Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121(12):2710–2716. https://doi.org/10.1002/lary.22369
Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7(2):110–114
Kim KT, Cho YW, Kim DE, Hwang SH, Song ML, Motamedi GK (2016) Two subtypes of positional obstructive sleep apnea: supine-predominant and supine-isolated. Clin Neurophysiol 127(1):565–570. https://doi.org/10.1016/j.clinph.2015.06.009
Koutsourelakis I, Safiruddin F, Ravesloot M, Zakynthinos S, de Vries N (2012) Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome. Laryngoscope 122(11):2587–2591
Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9(5):433–438. https://doi.org/10.5664/jcsm.2658
Huntley C, Chou D, Doghramji K, Boon M (2017) Preoperative drug induced sleep endoscopy improves the surgical approach to treatment of obstructive sleep apnea. Ann Otol Rhinol Laryngol 126(6):478–482
Certal VF, Pratas R, Guimarães L, Lugo R, Tsou Y, Camacho M, Capasso R (2015) Awake examination versus DISE for surgical decision making in patients with OSA: a systematic review. Laryngoscope 126(3):768–774
Ravesloot M, White D, Heinzer R, Oksenberg A, Pépin J (2017) Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med : Off Publ Am Acad Sleep Med 13(6):813–824
Hoekema A, Stegenga B, De Bont LG (2004) Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev Oral Biol Med 15(3):137–155
van Kesteren ER, van Maanen JP, Hilgevoord AA, Laman DM, de Vries N (2011) Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. Sleep 34(8):1075–1081. https://doi.org/10.5665/SLEEP.1164
Zhu K, Bradley TD, Patel M, Alshaer H (2017) Influence of head position on obstructive sleep apnea severity. Sleep Breath 21(4):821–828. https://doi.org/10.1007/s11325-017-1525-2
Eichler C, Sommer JU, Stuck BA, Hormann K, Maurer JT (2013) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 17(1):63–68. https://doi.org/10.1007/s11325-012-0647-9
Safiruddin F, Koutsourelakis I, de Vries N (2014) Analysis of the influence of head rotation during drug-induced sleep endoscopy in obstructive sleep apnea. Laryngoscope 124(9):2195–2199
Safiruddin F, Koutsourelakis I, de Vries N (2015) Upper airway collapse during drug induced sleep endoscopy: head rotation in supine position compared with lateral head and trunk position. Eur Arch Otorhinolaryngol 272(2):485–488
Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128(4):2130–2137. https://doi.org/10.1378/chest.128.4.2130
Oksenberg A (2005) Positional and non-positional obstructive sleep apnea patients. Sleep Med 6(4):377–378. https://doi.org/10.1016/j.sleep.2005.03.012
Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950. https://doi.org/10.1007/s00405-006-0090-2
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N. de Vries is consultant to NightBalance, Philips and Olympus and researcher for Inspire and JAZZ pharmaceuticals. P.E. Vonk and A.M.E.H. Beelen declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Vonk, P.E., Beelen, A.M.E.H. & de Vries, N. Towards a prediction model for drug-induced sleep endoscopy as selection tool for oral appliance treatment and positional therapy in obstructive sleep apnea. Sleep Breath 22, 901–907 (2018). https://doi.org/10.1007/s11325-018-1649-z
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DOI: https://doi.org/10.1007/s11325-018-1649-z